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INCREASED URINARY ADIPONECTIN LEVEL IS ASSOCIATED WITH CONTRAST-INDUCED NEPHROPATHY IN PATIENTS UNDERGOING PCI
E1174 JACC March 12, 2013 Volume 61, Issue 10
Chronic CAD/Stable Ischemic Heart Disease Increased Urinary Adiponectin Level Is Associated with Contrast-Induced Nephropathy in Patients Undergoing PCI Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Rock and a Hard Place: Chronic Kidney Disease and the Heart Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical Presentation Number: 1193-63 Authors: Junyi Zhang, Yanbin Song, Yan Qu, Kun Lian, Rutao Wang, Lu Sun, Jaekyoung Hong, Xue-Qiao Zhao, Ling Tao, University of Washington, Seattle, WA, USA, China Fourth Military Medical University, Xian, People’s Republic of China Background: Contrast-induced nephropathy (CIN) is one of major complications in patients undergoing PCI. We prospectively examined the association of urinary adiponectin (UAPN), a sensitive marker for early renal function impairment, with CIN. Methods: We enrolled 208 patients without severe hepatic and renal function abnormality and LVEF<20% who underwent elective PCI from Feb. 2011 to May 2012. The mean age was 61±10 years, 80% were male, 65% with hypertension, 45% with dyslipidemia and 35% with type-2 diabetes. 1-, 2- and 3-vessel CAD was seen in 18%, 25% and 57% of patients, respectively. All subjects received a standard of care including antithrombotic therapy, statin, blood pressure control and diabetes management prior and post PCI. The average volume of contrast given was 235±122 ml per patient. Renal function was assessed prior to PCI and monitored for 72 hours post PCI. CIN was identified following ESUR criteria as 25% increase in creatinine level from baseline within 72 hours of contrast use and no other reasons could explain such creatinine raise. UAPN was assessed using Elisa 24 hour prior to PCI and its 4th quartile was ≥12.36 ng/ml. Logistic regression was used to assess CIN associated risk. Results: Of 208 patients, 19 (9%) developed CIN and 6 required dialysis. Patients with CIN had a higher prevalence of diabetes, higher hip to waist ratio, higher creatinine and HsCRP levels, lower hemoglobin and total protein levels, lower LVEF and higher volume of contrast used, additionally, higher UAPN level (17.15 vs. 10.29 ng/ml, p<0.001). The number of patients with UAPN ≥12.36 ng/ml was significantly larger in CIN (63 vs. 22%, p<0.001). Multivariate analysis showed that elevated fasting glucose, increased creatinine, lower LVEF and UAPN ≥12.36 ng/ml were significantly and independently associated with CIN. The risk of CIN was 6-fold higher (OR=6.03, p=0.02) in patients with UAPN ≥12.36 ng/ml compared to those with <12.36 ng/ml. Conclusions: Patients with highest quartile of UAPN (≥12.36 ng/ml) are at a significantly higher risk for developing CIN post PCI. In addition to renal function assessment, UAPN levels could be useful in predicting CIN that requires closer monitoring post PCI.
Chronic CAD/Stable Ischemic Heart Disease Increased Urinary Adiponectin Level Is Associated with Contrast-Induced Nephropathy in Patients Undergoing PCI Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Rock and a Hard Place: Chronic Kidney Disease and the Heart Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical Presentation Number: 1193-63 Authors: Junyi Zhang, Yanbin Song, Yan Qu, Kun Lian, Rutao Wang, Lu Sun, Jaekyoung Hong, Xue-Qiao Zhao, Ling Tao, University of Washington, Seattle, WA, USA, China Fourth Military Medical University, Xian, People’s Republic of China Background: Contrast-induced nephropathy (CIN) is one of major complications in patients undergoing PCI. We prospectively examined the association of urinary adiponectin (UAPN), a sensitive marker for early renal function impairment, with CIN. Methods: We enrolled 208 patients without severe hepatic and renal function abnormality and LVEF<20% who underwent elective PCI from Feb. 2011 to May 2012. The mean age was 61±10 years, 80% were male, 65% with hypertension, 45% with dyslipidemia and 35% with type-2 diabetes. 1-, 2- and 3-vessel CAD was seen in 18%, 25% and 57% of patients, respectively. All subjects received a standard of care including antithrombotic therapy, statin, blood pressure control and diabetes management prior and post PCI. The average volume of contrast given was 235±122 ml per patient. Renal function was assessed prior to PCI and monitored for 72 hours post PCI. CIN was identified following ESUR criteria as 25% increase in creatinine level from baseline within 72 hours of contrast use and no other reasons could explain such creatinine raise. UAPN was assessed using Elisa 24 hour prior to PCI and its 4th quartile was ≥12.36 ng/ml. Logistic regression was used to assess CIN associated risk. Results: Of 208 patients, 19 (9%) developed CIN and 6 required dialysis. Patients with CIN had a higher prevalence of diabetes, higher hip to waist ratio, higher creatinine and HsCRP levels, lower hemoglobin and total protein levels, lower LVEF and higher volume of contrast used, additionally, higher UAPN level (17.15 vs. 10.29 ng/ml, p<0.001). The number of patients with UAPN ≥12.36 ng/ml was significantly larger in CIN (63 vs. 22%, p<0.001). Multivariate analysis showed that elevated fasting glucose, increased creatinine, lower LVEF and UAPN ≥12.36 ng/ml were significantly and independently associated with CIN. The risk of CIN was 6-fold higher (OR=6.03, p=0.02) in patients with UAPN ≥12.36 ng/ml compared to those with <12.36 ng/ml. Conclusions: Patients with highest quartile of UAPN (≥12.36 ng/ml) are at a significantly higher risk for developing CIN post PCI. In addition to renal function assessment, UAPN levels could be useful in predicting CIN that requires closer monitoring post PCI.